Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $120.55 / $207.72 / $1,197.00	Facility		$120.55	$207.72	$1,197.00
Aetna Facility/Professional Facility Modifier 25 Low / Median / High Price $387.56 / $2,997.78 / $6,595.34	Facility	25	$387.56	$2,997.78	$6,595.34
Aetna Facility/Professional Professional Modifier Low / Median / High Price $92.71 / $121.05 / $314.83	Professional		$92.71	$121.05	$314.83
Aetna Facility/Professional Professional Modifier 25 Low / Median / High Price $101.12 / $190.60 / $698.85	Professional	25	$101.12	$190.60	$698.85
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $102.96 / $193.56 / $330.81	Professional		$102.96	$193.56	$330.81
Ambetter Facility/Professional Professional Modifier 25 Low / Median / High Price $116.96 / $203.72 / $385.89	Professional	25	$116.96	$203.72	$385.89
Asuris Northwest Health Facility/Professional Facility Modifier Low / Median / High Price $15.00 / $481.38 / $481.38	Facility		$15.00	$481.38	$481.38
Asuris Northwest Health Facility/Professional Professional Modifier Low / Median / High Price $145.72 / $243.00 / $1,183.50	Professional		$145.72	$243.00	$1,183.50
Asuris Northwest Health Facility/Professional Professional Modifier 25 Low / Median / High Price $200.52 / $200.52 / $224.56	Professional	25	$200.52	$200.52	$224.56
Cigna Facility/Professional Facility Modifier Low / Median / High Price $10,657.00 / $10,657.00 / $11,161.00	Facility		$10,657.00	$10,657.00	$11,161.00
Cigna Facility/Professional Professional Modifier Low / Median / High Price $114.54 / $203.73 / $335.11	Professional		$114.54	$203.73	$335.11
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $107.26 / $195.00 / $277.35	Facility		$107.26	$195.00	$277.35
Kaiser Permanente Facility/Professional Professional Modifier Low / Median / High Price $104.00 / $191.98 / $283.86	Professional		$104.00	$191.98	$283.86
Molina Facility/Professional Professional Modifier Low / Median / High Price $29.02 / $157.44 / $288.73	Professional		$29.02	$157.44	$288.73
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $168.12 / $227.52 / $239.86	Facility		$168.12	$227.52	$239.86
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $160.11 / $249.60 / $309.63	Professional		$160.11	$249.60	$309.63
Regence BlueShield Facility/Professional Professional Modifier Low / Median / High Price $151.65 / $210.04 / $285.63	Professional		$151.65	$210.04	$285.63
United Facility/Professional Professional Modifier Low / Median / High Price $126.78 / $187.62 / $342.75	Professional		$126.78	$187.62	$342.75
United Facility/Professional Professional Modifier 25 Low / Median / High Price $80.00 / $85.00 / $255.60	Professional	25	$80.00	$85.00	$255.60
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $98.56 / $110.12 / $125.51	Professional		$98.56	$110.12	$125.51